Electronic Agency Account Request

To request a new account with an online agency, please send the following information in an e-mail to Carol Rafalski at crafalsk@uwf.edu:


Agency:  NSF / NIH / Other:

First Name Middle Initial Last Name:   

Date of Birth (Required* for NIH):    

Agency Required ID:     Most electronic systems require a unique ID and, in some cases, a SSN, for the record. After your e-mail request is received, the Research & Sponsored Programs specialist maintaining your account will contact you by phone to establish an ID for your agency needs.

E-mail:   

Phone Number:   

Fax Number:   

Department:   

College:   

Mailing Address:   

Highest Degree:  

Conferred:   

Have you previously submitted a proposal to or received an award from a federal agency?         Yes / No

If so, please provide the agency proposal/award number:   

Have you ever served as a principal investigator, co-principal investigator, or senior key personnel on a federally-sponsored project?    Yes / No

If so, please list current or most recent awards:
 


*If you have any questions or do not wish to provide this information electronically, please contact Carol Rafalski at 474-2825.